MEDICARE: DR. KEVIN J CRAIG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	4301072786	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	383694638	OTHER	MI	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952456816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN J CRAIG MD

Provider Business Mailing Address
First Line	:	11607 N SPARROW LN
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-5045
Country	:	US
Telephone Number	:	517-402-5811
Fax Number	:	480-718-7651

Provider Business Practice Location Address
First Line	:	11607 N SPARROW LN
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-5045
Country	:	US
Telephone Number	:	517-402-5811
Fax Number	:	480-718-7651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	01/13/2017

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